Pachychoroid disease of retina is a spectrum of diseases manifested by thickening and hyperperfusion of the choroid with changes in the sensory part of the retina. The main unit of this group is central serous chorioretinopathy (CSC). In practice, we often encounter other conditions, which are manifested by thickening of the choroid and changes in the retina, but they cannot be classified as pachychoroid diseases. The aim of this study is to point out on a series of 3 case reports the difficulties in the differential diagnosis of retinal diseases in which we find thickening of the choroid.
Case report 1: 42-year-old patient treated for central serous chorioretinopathy. After optical coherence tomography (OCT), fluorescence angiography (FAG) and indocyanine green angiography (ICG) the diagnosis was changed to choroidal hemangioma and he was treated with photodynamic therapy (PDT) which led to a reduction of the hemangioma.
Case report 2: A 30-year-old patient treated for ankylosing spondylitis comes for visual impairment in the left eye. On OCT the condition resembled chronic CSC. The patient suffered from a febrile exanthema a few days ago. Serological testing for coxsackievirus was positive and the diagnosis was changed to acute chorioretinitis in coxsackievirus infection. Oral treatment with prednisone was successful.
Case report 3: A 46-year-old patient was treated conservatively for CSC. After FAG and ICG, a solitary dilated choroidal vessel was found in the area of the papillomacular bundle with leakage under the sensory epithelium which was diagnosed as choroidal macrovessel. We performed PDT with a very good anatomical effect.
Conclusion: Precise differentiation of these mentioned diseases from pachychoroid retinal diseases was essential in choosing the appropriate therapy. The use of all modern imaging methods of the retina and choroid plays a key role in determining the diagnosis.